Annals of internal medicine
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To examine the stability of patients' choices for life-sustaining treatments. ⋯ Most patients (85%) who had chosen to forego life-sustaining treatments did not change their choices. Nonetheless, these data suggest that it is important to review patients' preferences for life-sustaining treatments rather than to assume the stability of their choices.
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To determine the role of the clinical training environment and a medical education community in reaffirming medical professionalism among physicians-in-training and faculty. ⋯ Establishment of a firm system with a core teaching faculty, creation of mentoring and role modeling programs, implementation of a longitudinal curriculum on medical professionalism, evaluation of physicians on professional conduct, and evaluation of the clinical training environment are suggested as strategies to re-establish an education community and reaffirm professionalism in medicine.
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Historical Article
The academic physician-investigator: a crisis not to be ignored.
The academic physician-investigator faces many challenges. Obtaining funding to support research is the greatest impediment. The National Institutes of Health, the single largest source of grants for the academic physician-investigator, approved only 14.2% of new investigator grant applications in 1990, compared with 40% in 1965 and 1975. ⋯ These two facts, reduced probability of obtaining a grant and the perceived need to see more patients for salary support, may jeopardize retention of young faculty members. Moreover, training to prepare physicians for academic careers has been poor, with no attention given to the projected needs of the academic centers or the nation. This article describes the dilemma facing young physician-investigators and provides recommendations for improvement to the leaders of American medicine.
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Randomized Controlled Trial Clinical Trial
Utility of selective digestive decontamination in mechanically ventilated patients.
To assess selective digestive decontamination for preventing nosocomial pneumonia and mortality in mechanically ventilated patients. ⋯ Selective digestive decontamination in our mechanically ventilated patients significantly decreased the colonization rate of gram-negative bacilli and of Candida species but not of Staphylococcus aureus. It did not decrease the incidence of nosocomial pneumonia, mortality, length of stay, or the duration of mechanical ventilation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Lack of pharmacologic tolerance and rebound angina pectoris during twice-daily therapy with isosorbide-5-mononitrate.
To determine whether isosorbide-5-mononitrate (IS-5-MN), an active metabolite of isosorbide dinitrate, when given twice daily (in the morning and 7 hours later), prevents development of tolerance and reduction in exercise performance or is associated with a rebound increase in anginal attacks in patients with stable angina pectoris. ⋯ Isosorbide-5-mononitrate, 20 mg twice daily given 7 hours apart, was well tolerated and improved exercise performance for 7 hours after the morning dose and for 5 hours after the afternoon dose without evidence of development of pharmacologic tolerance. No rebound increase in anginal attacks was found.